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Experience of advance directives in a hospice center.

Kong BH, An HJ, Kim HS, Ha SY, Kim IK, Lee JE, Park YJ, Kang YJ, Kim YR, Kim HK - J. Korean Med. Sci. (2015)

Bottom Line: As a proxy, the majority of patients preferred their spouses (55.3%).The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days.Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. ; Hospice Center, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

ABSTRACT
To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

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Preference for items of care in advance directives.
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Figure 1: Preference for items of care in advance directives.

Mentions: Of the 76 patients who signed ADs, 70 (92.1%) completed ADs with their caregivers. As for life-sustaining procedures, only one patient (1.3%) preferred cardiopulmonary resuscitation. Four patients (5.3%) wanted hemodialysis; of these, three had normal renal function, the remaining patient had third-stage chronic renal failure, and none of the patients received maintenance dialysis. Seventeen patients (22.4%) wanted artificial nutritional support; of these, seven had gastrointestinal cancer, four had lung cancer, four had hepatobiliary cancer, one had nasopharyngeal cancer, and one had peritoneal cancer. Sixty-eight patients (89.5%) wanted palliative sedation (Fig. 1). As a proxy, 55.3% preferred spouses, 28.9% sons/daughters, 7.9% siblings, and 6.6% parents (Table 2).


Experience of advance directives in a hospice center.

Kong BH, An HJ, Kim HS, Ha SY, Kim IK, Lee JE, Park YJ, Kang YJ, Kim YR, Kim HK - J. Korean Med. Sci. (2015)

Preference for items of care in advance directives.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310940&req=5

Figure 1: Preference for items of care in advance directives.
Mentions: Of the 76 patients who signed ADs, 70 (92.1%) completed ADs with their caregivers. As for life-sustaining procedures, only one patient (1.3%) preferred cardiopulmonary resuscitation. Four patients (5.3%) wanted hemodialysis; of these, three had normal renal function, the remaining patient had third-stage chronic renal failure, and none of the patients received maintenance dialysis. Seventeen patients (22.4%) wanted artificial nutritional support; of these, seven had gastrointestinal cancer, four had lung cancer, four had hepatobiliary cancer, one had nasopharyngeal cancer, and one had peritoneal cancer. Sixty-eight patients (89.5%) wanted palliative sedation (Fig. 1). As a proxy, 55.3% preferred spouses, 28.9% sons/daughters, 7.9% siblings, and 6.6% parents (Table 2).

Bottom Line: As a proxy, the majority of patients preferred their spouses (55.3%).The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days.Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. ; Hospice Center, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

ABSTRACT
To protect patient autonomy when confronting death, the importance of advance directives (ADs) has recently became an issue and gradually accepted in Korea. However, in real practice, ADs were not completed by patients but their families in most cases. To analyze the current situation of performing ADs, we reviewed medical charts of 214 terminal cancer patients admitted to the hospice center from October 2012 to September 2013. Seventy-six (35.5%) patients completed ADs. All ADs were completed by patients themselves. The most common reason for not completing ADs was poor physical and/or mental condition. As a proxy, the majority of patients preferred their spouses (55.3%). Few patients wanted life sustaining treatment (1.3%), however palliative sedation was accepted in 89.5%. The median timing of ADs after admission was three (0-90) days, and duration of survival since ADs was 22 (1-340) days. In conclusion, approximately one third of terminal cancer patients completed ADs by themselves. Considering that patient's poor condition is the main reason for not completing ADs, earlier discussion regarding ADs is necessary to enhance patients' participation.

Show MeSH
Related in: MedlinePlus